Journal of Indian Association of Pediatric Surgeons
Journal of Indian Association of Pediatric Surgeons
                                                   Official journal of the Indian Association of Pediatric Surgeons                           
Year : 2005  |  Volume : 10  |  Issue : 1  |  Page : 41--43

Role of ultrasonography in the evaluation of children with acute abdomen in the emergency set-up


Aviral, RS Chana, Ibne Ahmad 
 Pediatric Surgery Division, Department of Surgery, J.N.M.C., Aligarh, India

Correspondence Address:
R S Chana
, HIG 21, Avantika phase 2, ADA colony, Ramghat Road, Aligarh - 202002
India

Abstract

Background: Acute abdomen in children has been aptly described as Pandora«SQ»s box. Unlike computerized tomography (CT scan), ultrasonography (USG) has no radiation hazard and the present study analyses the diagnostic yield of the USG in acute abdomen in children. Materials and Methods: Between September 2001 to October 2003, 75 patients with acute abdomen underwent clinical examination, routine biochemical tests, erect X-ray abdomen, USG and CT scan. Laparotomy and histological examination established final diagnosis. Results: The accuracy of correct diagnosis was 60%, 66.6%, 64%, 98.7% with clinical examination alone, USG alone, clinical examination combined with conventional radiography, and clinical evaluation combined with conventional radiography and USG respectively. USG helped to prevent unnecessary laparotomy in 16.3% of patients. Conclusions: USG is good investigative modality in the management of acute abdomen in children.



How to cite this article:
Aviral, Chana R S, Ahmad I. Role of ultrasonography in the evaluation of children with acute abdomen in the emergency set-up.J Indian Assoc Pediatr Surg 2005;10:41-43


How to cite this URL:
Aviral, Chana R S, Ahmad I. Role of ultrasonography in the evaluation of children with acute abdomen in the emergency set-up. J Indian Assoc Pediatr Surg [serial online] 2005 [cited 2021 Apr 18 ];10:41-43
Available from: https://www.jiaps.com/text.asp?2005/10/1/41/16075


Full Text

Acute abdomen can be defined as "A syndrome induced by wide variety of pathological conditions that require emergent medical or more often surgical management". There are a plethora of cases ranging from benign conditions like viral gastroenteritis to intussusception that can lead to acute abdomen in children. This vivid etiology, the occult nature of disease and difficulties encountered in examining these children prompted surgeons to look for some reliable diagnostic adjuncts for accurately diagnosing the intra-abdominal pathology in order to prevent negative celiotomies; which is not uncommon in children.

Plain radiograph of the abdomen has been used conventionally in the diagnostic workup of the children with acute abdomen however, its diagnostic yield is limited because of its high non-specificity and low sensitivity.

Ultrasonography since its use by Puylaert et al. in 1986 (6) for diagnosing acute abdomen pre-operatively, has been used in various acute abdominal conditions. It has been found to confirm the primary diagnosis in 21-34% of patients and second / third differential diagnosis in further 12% of patients, when used alone as a diagnostic modality. Ultrasonography is very useful in children because it is non-invasive, cost- effective, repetitive and doesn't expose the child to radiation. It is as good as laparoscopy and can be done even in patients with scarred abdomen. It can be done as a bedside investigation.[2-5]

The purpose of this study was to evaluate the role of sonography in the diagnostic work-up of children with acute abdomen in the emergency set-up and also its role in making decision regarding surgery.

 Materials and methods



During a period from September 2001 to October 2003, 75 patients (5 MHz). In our study ultrasonographic examination was misleading in two patients. In both patients it suggested the diagnosis of intestinal obstruction but on further evaluation (Barium meal and CT scanning) they were diagnosed as cases of Hypertrophic pyloric stenosis and Pancreatitis.

Surgery was planned in 82.67% patients prior to performing ultrasound but after performing it the need for surgical intervention decreased to 69.33% of patients. Thus ultrasonography changed the management plan in 16.13% of patients. These patients did not require any surgical intervention and responded well to the conservative treatment. Walsh et al[10] and Davis et al[11] in their studies also found the change in the plan of management in 11-22% of cases.

Nothing can replace the clinical acumen of the physician, ultrasonography should however be used as an adjunct to the clinical evaluation and plain abdominal radiographs rather than replacing them as it adds to useful diagnostic information in 34.67% of patients. It will lead to faster diagnosis and earlier institution of necessary operative or radiological intervention procedures. Also it significantly changes the management plan in about 16% of patients thereby lowering not only the financial outlay for managing the acute abdominal pathology but also the mortality and morbidity rates in these patients with acute abdomen who otherwise would have undergone unnecessary laparotomies.

References

1Carmody E, McGrath EF, Keeling F. The role of emergency ultrasonography in the management of the acute abdomen. Proceedings of the British Medical Ultrasound Society 1990;63:383.
2Verbanck JJ, Aelst FV, Rutgeerts L, et al . The impact of routine admission abdominal sonography on patient care. J Clin Ultra 1988;16:651-4.
3Lerch MM, Riehl J, Buechsel R, et al . Bedside ultrasound in decision making for emergency surgery: Its role in medical intensive care patients. Am J Emer Med 1992;10:35-8.
4Gupta H, Dupuy DE. Advances in imaging of the acute abdomen. Surg Clin North Am 1997;77:1245-63.
5Simeone JF, Novelline RA, Ferrucci JJ, et al . Comparison of sonography and plain films in evaluation of the acute abdomen. Am J Roent 1985;144:49-52.
6Puylaert JBCM - Acute appendicitis: Ultrasound evaluation using graded compression. Radiology 1986;158:355-60.
7Wittenberg J, Fineberg HV, Black EB, et al . Clinical efficacy of computed body tomography. AJR 1978;131:5-14.
8Fineberg HV, Wittenberg J, Ferrucci JT Jr, et al . The clinical value of body computed tomography over time and technologic change. AJR 1983;141:1067-72.
9Mendelson RM, Lindsell DRM. Ultrasound examination of paediatric "acute abdomen" preliminary findings. BJR 1987;60:414-6.
10Walsh PF, Crawford D, Crossling FT, et al . The value of immediate ultrasound in acute abdominal conditions: A critical appraisal. Clin Radiol 1990;42:47-9.
11Davies AH, Mastorakov I, Cobb R, et al . Ultrasonography in the acute abdomen. BJS 1991;78:1178-80.